Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study.
BACKGROUND
Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking.


METHODS
In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed.


RESULTS
Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P < .001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P < .001), and age older than 65 years was an independent predictor of mortality.


CONCLUSIONS
In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.
Durante-Mangoni
Emanuele
E
Department of Cardiothoracic and Respiratory Sciences, Università di Napoli II, Naples, Italy.
Bradley
Suzanne
S
Selton-Suty
Christine
C
Tripodi
Marie-Françoise
MF
Barsic
Bruno
B
Bouza
Emilio
E
Cabell
Christopher H
CH
Ramos
Auristela Isabel de Oliveira
AI
Fowler
Vance
V
Hoen
Bruno
B
Koneçny
Pam
P
Moreno
Asuncion
A
Murdoch
David
D
Pappas
Paul
P
Sexton
Daniel J
DJ
Spelman
Denis
D
Tattevin
Pierre
P
Miró
José M
JM
van der Meer
Jan T M
JT
Utili
Riccardo
R
D000367:Age Factors; D000368:Aged; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors